Review finds low-carb eating benefits wide range of health markers

I’m a long-time advocate of diets that are generally lower in carbohydrate than those encouraged by most Governments, health agencies and health professionals. I’m not very prescriptive about it, and prefer not in my talks or writings to give specific carbohydrate ‘targets’ e.g. no more than 50 g of carbohydrate a day. I do, however, advise those wanting to optimise their health and weight to avoid or limit foods with added sugar (sometimes even foods that are naturally sugary too), as well as reining in starchy carbohydrates such as bread, potatoes, rice, pasta and breakfast cereals.

Just this change in dietary tack will very often bring significant improvements in terms of weight and general wellbeing. The underlying mechanisms are probably various. But it occurs that this sort of eating regime will help to stabilise blood sugar levels, which so often seems to impact positively on things like energy levels, mood and sleep. Another thing is that many of the foods de-emphasised on this approach may have quite-toxic effects on the body. Many grains (particularly wheat), for instance, have the capacity to induce problems related to food intolerance that can cause problems such as fatigue and gastrointestinal symptoms. Grains aren’t particularly nutritious either, so losing a bunch of them is unlikely to lead to problems with nutrition status (despite what some health professionals would have us think).

Of course, not everyone is enthused by low-carb approaches, and some will publish articles or studies which are broadly critical of them. In one such study, it was claimed that the low-carb phenomenon is putting Swedish people in perilous danger. However, even a cursory glance at the design of the study reveals it’s simply not fit for purpose. It is my opinion that the authors are less motivated by a desire to get to the truth, and perhaps more motivated to produce whatever they can (however poor the science) to justify and support their biases against this dietary approach.

One of the reasons I say this is because it is widely recognised that the best judge of any approach (dietary or otherwise) is not the sort of junk ‘epidemiological’ science they churned out, but clinical studies. Studies where the approach is actually tried in real, live human beings.

My eye was caught today by a paper published yesterday which reviews the impact of low-carbohydrate eating on a range of health markers. The review amassed data from 17 studies in the form what is called a ‘meta-analysis’ [1]. This sort of review study is not necessarily ideal, at least in part because it included approaches utilising different carbohydrate intakes over different lengths in sometimes quite different demographics of people. Also, another problem is that in studies of this nature people are usually ‘free living’, and this means that adherence to the ‘diet’ is not assured and tends to drop off over time too.

Nevertheless, the broad results from this review make interesting reading in that, overall, low carbohydrate eating was found, on average to bring statistically significant benefits in several measures including:

Body weight (average loss of 7 kg)

Abdominal circumference (average reduction of 5.74 cm = 2.26 inches)

Systolic blood pressure (average reduction of 4.81 mmHg)

Diastolic blood pressure (average reduction of 3.10 mmHg)

HbA1c – also known as glycosylated haemoglobin and a measure of blood sugar control over the preceding 3 months or so (average reduction 0.21 per cent)

No overall effect was seen on levels of supposedly ‘unhealthy’ LDL cholesterol. Though, we know from research that low carbohydrate diets tend to lead to lead to increases in the size of LDL particles and reduce the number of ‘small, dense’ LDL – changes that are believed to be desirable in terms of cardiovascular disease risk reduction [2].

Taken as a whole, these effects can only really be seen as a sign that low-carb eating has broadly beneficial effects across just about every health markers it’s been judged with.

None of this, I suspect, will come as too much of a surprise to those who employ this strategy in practice, or to many people who have used it on themselves, in that similar results to those found in the studies will often stare us in the face. What is perhaps more surprising is how often doctors and health professionals seem unaware of the evidence for low-carb eating (or perhaps just choose to ignore it).

Those of us old enough will remember that up until about the early 1970s everyone knew that in order to lose weight, cutting down on carbohydrates (total elimination being almost impossible to achieve and neither necessary nor desirable) was the easiest and most effective method. It really was common knowledge. It was taught to me by my parents and grandparents, uncles and aunts, and even taught at school.

The British government encouraged adoption of a low carbohydrate diet in order to lose weight too. The Department of Health published a little yellow booklet which set out tables of data showing the carbohydrate content of all the common foods. Meat, fish and eggs were all encouraged; bread, potatoes, cornflakes, pasta and even bananas discouraged (if one wanted to shed weight). Guidance was given on which vegetables and fruits were relatively low in carbohydrate.

This line of thinking was overturned in the 1970s. Cholesterol and saturated fat became the new dietary villains. Eggs were, almost overnight, considered dangerous (yolks in particular). A fear of red meat took hold in the population that to this day has not entirely gone away.

“Of course, not everyone is enthused by low-carb approaches, and some will publish articles or studies which are broadly critical of them. In one such study, it was claimed that the low-carb phenomenon is putting Swedish people in perilous danger. However, even a cursory glance at the design of the study reveals it’s simply not fit for purpose.”

This advice is also not fit for purpose.

NHS Scotland Part of their dietary recommendations for diabetics.

Eat starchy foods at each meal !
Include plenty of starchy foods e.g. bread, potatoes, pasta, rice, breakfast cereals etc. Try to choose those that are higher in fibre, if possible. Some fibre rich foods can slow down the rise in blood sugar, which could improve your diabetic control.
Eat regular amounts of starchy foods at breakfast, lunch, tea and supper. They help to fill you up and should form the main part of all your meals. These foods include -

If anyone believes, this is suitable food for a type two non insulin using diabetic, they have zero understanding of the effect of high carb food on BG numbers. This dietary information can only lead to increased medication for almost all. Medication that has been proved to kill and maim countless times. Many Doctors believe type two diabetes is always progressive, they know this, because they go out of their way to ensure the prophesy is self fulfilling.

shocking diet recommendations eddie. i would not want to see my glucometer readings eating that. a 13 yr old relative of mine was recently diagnosed type 1 here in the states and his family was told he will need to limit carbs: no more than 75 A MEAL!! the kid will grow up thinking thats how he should eat because thats what the doctors told him. 225 carbs a day not counting snacks. family better stock up on insulin. he will need every drop eating that way. im really confused by the medical establishment over this. defies common sense and they supposedly are the experts.

Frank, it appears the advice given to American diabetics is as abysmal as ours. The NHS, DUK and ADA’s dietary information, is in my opinion, bordering on the criminal. There can be no better illustration than the gruesome statistics published by the NHS. Clearly no progress is being made against diabetes and it’s life changing and threatening complications.

NHS Statistics for 2008 2009:
Percentage of Type 1 diabetics with HbA1c greater than 7.5 per cent = 71.4 per cent.
Percentage of Type 2 diabetics with HbA1c greater than 7.5 per cent = 33.4 per cent.
Percentage of Type 1 diabetics with HbA1c greater than 10.0 per cent = 33.6 per cent.
Percentage of Type 2 diabetics with HbA1c greater than 10.0 per cent = 14.3 per cent.
These results are very similar to those found in 2006 – 2007 and 2007 – 2008.

The link below, gives more up to date information from the latest published NHS audit. But as you can see, no improvements regarding HbA1c have been achieved. Most clued up diabetics know where HbA1c + 7.5 will lead to. The American Dr. Richard Bernstein, and over 50 years a type one diabetic, who is still fit, healthy and working, believes diabetics have the right to hold non diabetic BG numbers. This will never ever be achieved on a high carb-high medication regime.

For over four years I have asked this question of healthcare professionals. How do I keep non diabetic BG numbers, good lipids, and safe stable weight on a few metformin a day other than lowcarb ? The silence has been deafening. Like many other diabetics, I have been told “If it works for you stick with it”

Doctors Richard Bernstein, Jay Wortman, Katharine Morrison, Malcolm Kendrick, Charles Clarke, and many others, including the owner of this blog, knows the answer. And it is not more meds. For type two diabetics a big change in diet and lifestyle is essential for a long, active and healthy life. For type ones, less carbs equals less insulin, less insulin equals greater predictability and better control. As Professor Charles Clarke says “This is not rocket science” Bernstein calls this “the power of small numbers”

Ah but Eddie, here in the states levels of cholesterol have dropped by 40 percent or so and that’s ALL THAT MATTERS apparently!! Gotta lower that cholesterol! My GOD man! YOU can’t eat FAT! Are you crazy?? Stuff in that pasta and bread and oatmeal but NOT ANY fat!! Meanwhile, americans grow fatter, more obese, more diabetic and, sadly, more DEAD, limbless, blind….I’m sure you know Eddie, but cholesterol ALSO is made by the body as well as residing in foods. So the elimination of something that occurs naturally in our bodies (a hopeless task, no?) must take precedence over limiting foods that cause blood glucose to increase dangerously in diabetics? Madness. Doctors are not stupid. They SHOULD know what carbs do physiologically. But apparently institutional medicine is convinced that eating more fat poses a far greater risk than carbs causing dangerously high blood glucose and then medicating the heck out of patients to try to deal with those high levels, and failing of course. We need to challenge the conventional medical wisdom when it flies in the face of common sense. Just like the days when surgeons attacked your countryman Lister and others when it was suggested they wash their hands and sterilize their operatories. No sense doing that nonsense!! Dangerous foolishness! Eating low carb? Dangerous foolishness! Everyone knows there’s no reason for that! Eat those carbs! Re-use those scalpels!

Great post. Some rubbish advice for sure. As a Canadian doctor, I have seen our and the British guidelines, and they are not good for people with diabetes. I’m mindful always to mention the low carb approach to diabetes management and pursue it if patient’s are interested.

I like Mary Vernon’s video on dietdoctor.com, where she describes asking patients whether they would like to go on more medications for their diabetes, or whether they would like to try a diet so they can take away their medications!

Jay Wortman’s, My Big Fat Diet is another resource that I use.

A lower carb approach is something I learned outside of medical training, but the information is out there. I liked Tom Naughton’s Crisis In Nutrition Video about the power of the internet.

I believe the saturated fat theory causing heart disease and stroke is wrong. The cholesterol theory will one day be seen as the biggest con ever pushed by big pharma and the medical profession. Why should we trust big pharma ? Have they not been fined billions of dollars in recent years for selling off prescription, falsifying evidence and bribery and corruption. Most well controlled diabetics know the standard dietary advice regarding carb consumption is so far wrong, it would be laughable but for the countless thousands it kills and maims every year.

“Dr Malcolm Kendrick looked at figures gathered by the World Health Organization on saturated-fat￼￼ consumption and heart-disease rates in countries throughout Europe.

He then grouped them into the seven countries with the lowest consumption of saturated fat, and compared this to their rate of heart disease, and also grouped the seven countries with the highest consumption of saturated fat and compared this to their rate of heart disease.

Every single one of the seven countries with the lowest saturated-fat consumption has significantly higher rates of heart disease than every single one of the seven countries with the highest saturated-fat consumption.”

“A meta-analysis published in the American Journal of Clinical Nutrition, pooled together data from 21 unique studies that included almost 350,000 people, about 11,000 of whom developed cardiovascular disease (CVD), tracked for an average of 14 years, and concluded that there is no relationship between the intake of saturated fat and the incidence of heart disease or stroke.

Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.” Sugar, refined carbs, hydrogenated fats, HFCS ?

The Cholesterol Myth exposed by Dr Malcolm Kendrick who speaks about the World Health Organisation data
gathered in their MONICA study. This shows there is no correlation between heart disease and cholesterol numbers.

“The reality is that over the years, and around the world we have killed literally millions of diabetics by advising them to eat a high-carb diet and avoid fats. Only now is it being recognised that previous advice was and remains useless, dangerous and scientifically illiterate. The authors of this Cochrane review should be applauded for taking the fist step on a path that will, inevitably, result in the destruction of the nonsense.”

“I like Mary Vernon’s video on dietdoctor.com, where she describes asking patients whether they would like to go on more medications for their diabetes, or whether they would like to try a diet so they can take away their medications!”

My dream is that all medical professionals will inform diabetics there is an alternative to eating starchy foods with every meal, which very often results in chasing highly elevated blood glucose numbers, with ever increasing medication. The NHS stats prove current diabetes treatment is failing, and will continue to fail, until sensible dietary information based on fact rather than bent big pharma information and discredited science from the likes of Ancel Keys.

Preaching to the converted
Another Dr with T2DM of 15 years ( but of course for a lot longer, had I been cleverer…) and from Downunder we face the same dilemma of gross misinformation. Sadly, I think only litigation may be effective, or as Max Planck would famously say, we wll only advance one funeral at a time. Meanwhile the diabetic associations,seemingly worldwide,with their invocations concerning the need for a ” Team ” to treat this disorder keep up their bizarre advice. Diabetic educators need to be a designated job, available only to those who actually have T2DM. After all, we are thick on the ground.
I suppose that at the end of the day, when the $ to treat this tsunami is greater than the money being made by the Food people who give us such breakfast gems as rice bubbles and weetabix and as more and more politicians get some personal empathy, Doctors like some of us can only chip away. But it is refreshing to read your blogs Eddie et al. And to be steered to some sensible sites. I happen to be a Scottish graduate and feel ashamed to be associated with such nonsense as promulgated by NHS Scotland.

I find that low-carb and paleo style diets are among the best choices for acne and other skin problems. Acne at least comes largely down to insulin and IGF-1 hormones. Reducing carb intake is one of the best ways to rein back those hormones.

The problem with high-fat diets is the insulin resistance they cause. Lot of acne patients on low-carb diets tend to get horrible acne when they slip and eat some carbohydrates. Any ideas on treshold levels? Like what % of calories you can eat fat without creating insulin resistance and insulin spikes in response to eating some carbohydrates?

“Eddie Mitchell – are you the infamous Eddie who used to contribute aggressively to the http://www.diabetes.co.uk/forum ? And you are still alive & well after 4 years low carb?”

Yes I am the infamous Eddie, stalwart scourge of the low carb antis and dietitions who should know better. Contrary to the dire warnings from the ex resident dietition at diabetes.co.uk, I have not succumbed to scurvy, osteoporosis, constipation, kidney failure, yellow jack or mange. Thank you for enquiring about my health. I am doing very well thanks, as are many of the departed members of the aforementioned forum.

I am in regular contact with many of the early forum low carb members. Fergus, Graham64, John Wilson, Ray Davies, Wallycorker, and others. Some of us meet a couple of times a year for a meal and chew the saturated fat, all are doing very well. Fergus still holds HbA1c in the mid fours, and works hard promoting the lowcarb cause. Between us we have been lowcarbing well over fifty years and no increase in diabetes medication. Some are meds free to this day. I read your posts and am chuffed to see you and people like Hana doing well. I also appreciate the work you do for others, trying to reform the lamentable dietary advice at DUK meetings.

Good luck and health to all.

Apologies to Dr. Briffa for turning this thread into friends re-united, I won’t make a habit of it.

So interested to read all your comments, especially the first from Mark on 24 Aug, pinpointing a complete reversal of previous medical advice for the management of diabetes. My husband has type 2 diabetes, most probably triggered by the use of steroids to control myasthenia gravis. Because he trusts his doctor and the diabetes nurse he sticks rigidly to making a third of his intake carbohydrate. I keep trying to get him to entertain the idea that the current ‘fashion’ in dietary advice for diabetics is merely that, and could be disastrous for him. I’m forwarding him this blog and your responses in the hope that he might at least TRY the low-carb approach. Many thanks for all the time you’ve put in to your replies, and of course to Dr John and his excellent book for fighting the good fight …

I have lost 20lbs in 7 weeks! And still losing. I now have energy to last me all day. I’m thrilled with the results. I run 5 days a week. My usual day of eating is breakfast: a hard boiled egg with coffee without sugar & sugar free cream. I also take vitamins: b12, iron, multi-vitamin & fish oil. Lunch: salad, with grilled chicken, light ranch & cheese. Snack: carb master yogurt (low carb yogurt). Dinner: slim fast low carb shake. I don’t eat dinner late or snack afterwards. Atkins isn’t just eating fat. You can do Carb free Diet, low calorie, high fiber, high protein. Be smart & live well.

[...] He says there is an enormous amount of scientific research that supports low-carb diets – particularly studies which find them superior to low-fat, calorie-restricted diets for weight loss – and the internet shows “first hand accounts from countless individuals who have transformed their health for the better using low-carbohydrate eating”. [...]

[...] He says there is an enormous amount of scientific research that supports low-carb diets – particularly studies which find them superior to low-fat, calorie-restricted diets for weight loss – and the internet shows “first hand accounts from countless individuals who have transformed their health for the better using low-carbohydrate eating”. [...]

[...] He says there is an enormous amount of scientific research that supports low-carb diets – particularly studies which find them superior to low-fat, calorie-restricted diets for weight loss – and the internet shows “first hand accounts from countless individuals who have transformed their health for the better using low-carbohydrate eating”. [...]

[...] He says there is an enormous amount of scientific research that supports low-carb diets – particularly studies which find them superior to low-fat, calorie-restricted diets for weight loss – and the internet shows “first hand accounts from countless individuals who have transformed their health for the better using low-carbohydrate eating”. [...]

[...] He says there is an enormous amount of scientific research that supports low-carb diets – particularly studies which find them superior to low-fat, calorie-restricted diets for weight loss… [...]

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